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6 Month Post-Op Exam

lilac100llilac100 Posts: 180
edited 06/11/2012 - 7:42 AM in Back Surgery and Neck Surgery
Well Thursday I had my 6 month check up. It seemed to go really well. My bones actually did start fusing. He was sure one side was solid, but the other side still looks grainy on the x-ray. We discussed my continued pain, he believes it is either the one side not fusing or I'm not adjusting well to the hardware. He suggested 2 options. The first was a thin slice ct to get a better look at the bones. The second was wait 6 months, then do the CT. I chose to wait the six months because he said he wouldn't revise the fusion until then if it was the bones not completely fused, and the longer I kept the hardware the better my chances are of a truly solid fusion. He did a quick rundown of a revison surgery with new bigger hardware and a quick rundown of hardware removal if the bones were healed. He gave a prescription for lortab because he didn't like the idea of me hitting high pain levels and not having any kind of relief. He even said to stretch them out as far as I could. I almost laughed because I've been without painkillers for almost 3 months. It's been very hard not to quit my job and sit and cry some days. The pain is different than before surgery. That is why he thinks it is the hardware. No sciatic pain unless I get to high pain levels for long periods so we think the inflamation is causing pressure on nerves. I'm so in love with my doctor it is sick. He actually lectured me on my habit of not calling when the pain is bad. How many doctors think that way? I believe he doesn't think his job is done unless you are almost completely out of pain.

If anyone has experience with hardware causing pain I could use some stories. I'm not surprised by his thought of the hardware. I honestly thought I had broken one of the screws on the right side. I'm kind of happy and sad at the same time. The surgery did work it accomplished what we set out to do, remove the instability and fix the sciatic pain. The pain in my back as I said is different but it sucks all the same. Guess I'm in the cycle of pain that it seems a lot of us get stuck in, but I have hope. I'm still much better than I was.
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Comments

  • I haven't had a fusion but I think I'm in love with your doctor too! Basically for the same reason I'm in love (so far) with my doctor.

    It's so important.
    I am glad to hear you are fusing and hopefully in 6-months the pain will go away. If not, you have time to review your options until then and have 'breakthru' pain med to help on those bad days.

  • I had almost the same problem as you, except at L5-S1. I had the TLIF with decompression, 2 rods and 4 screws on February 2nd. I started having new, different pain around week 2. At my 1 month follow-up appointment, xrays showed the upper 2 screws had moved a tiny bit, some bone had started to grow in but not as well as on the bottom 2 that had not moved. I was given a brace, kept on restriction and given more pain meds. The pain was totally different and sometimes my level would get to 9 and I would just cry and cry. I thought the surgery had just completely failed. Am still having some pain, which I think is hardware related, but only on 1 side at this point. It is a different pain then before surgery. Although, my nerve pain has started in my leg again and I'm hoping it's just because I've been walking more and it's waking up.

    Had xrays yesterday and follow-up next Thursday. I looked at the xrays but can't tell anything from them. Hoping everything looks good.
  • One thing that surgeons not only discount, but in most cases do not even consider, is the soft tissue, muscle and fascia structure that support the spine...and can be a source of great pain.

    In your case, you had quite a bit of spondylolisthesis. I don't know whether your surgeon tried to realign you spine, but at least to some extent, the rods and hardware are causing it to move. This can cause a great deal of rearrangement in all the supporting tissue.

    I liken it to a trip to the orthodontist. After the wires are readjusted, it takes a period of time for the nerve root of the tooth to adjust and for the mouth to get used to it. Just about the time that happens, it is time to go back for another adjustment.

    I think spondylolisthesis patients have a bit of a more difficult time with recovery, depending on how much the vertebrae are being asked to realign.

    Some people are pretty well fused at six months, but, many are not. Problems with hardware are really quite rare. I would suggest you be patient for awhile longer, as the doctor suggested. Then, when you are fairly sure you are fused, you can have a hardware block to see if it is causing you pain.

    Another possibility that you could see with a scan would be if the BMP overgrew its boundaries, has attached to the nerve and is causing nerve pain. But I think you said the pain has been there since immediately after surgery, so that would probably rule out a BMP problem.

    I'm glad your surgeon wants to get to the bottom of your issues. Try to be patient. Continue with your plans for recovery and try to stay positive.

    Gwennie
  • Gwennie, I'm glad you posted your response, since I had pretty much the same diagnosis at a different level. Also, my spondylolthesis was caused by a pars fracture so my spine was definitely unstable and had been for who knows how long. Both spine doctors (one ortho & one neuro) I saw said they wouldn't waste my time with anything other then surgery because of the instability.

    I have a follow-up appointment next Thursday and am going to bring this up since I don't recall ever having it explained to me the way you did, which makes sense. I usually wake up stiff and sore, which I figure is par for the course at this point. I'm an early riser, between 5 - 6. Once I'm up and moving about, and had my coffee, of course, I do my first walk, between 8:00 - 9:00 a.m., which is between 20 - 25 minutes at this point. I usually do another walk around 3:30 - 4:00 in the afternoon, same amount of time. I am usually feeling pretty good until about 5 or 6 in the evening and then I am done for the night because I'm in a fair amount of pain. I'm still on oxycontin (20mg every 12 hours), valium (5mg, usually only take one around 6 p.m. each day since I seem to spasm at that time for some reason) and Percocet (5/325mg which I only take 1 per day in the evening, around 9:00, and only if needed). Like I said in my previous post, it is a completely different pain from prior to surgery, more stabbing and demanding my attention. My oxycontin times are 8:00 a.m. and 8:00 p.m. and my pain level by my evening one sometimes is as high as 8 lately.

    But Gwennie, your explanation makes sense to me when I think about it and they type of pain I'm having in my back now. It's very difficult to describe the pain exactly.

    I will let you and lilac know what my surgeon thinks about this. They didn't seem overly concerned at my last appointment about the screws having moved a little bit and said that was what was causing my pain.
  • Great Posts Gwennie and Gretchen.

    I always like reading your posts. I feel like the pain you're describing is my own. Except wrapping around my hip. Inside of thigh is crazy today. My spine has been unstable for almost 4 years. So all of this makes sense. But it is beyond uncomfortable at this point. It is painful and I cry a lot. My fusion looked great last week, you can see the bone filling in perfectly. But my Dr no longer has my undying love since he didn't offer any further explanation for my pain than "part of the healing process." Not good enough for me. I know too much (from SH of course.) I am not giving up though. I want to get back something of a normal life.

    Thanks,
    Traci
  • I already printed this page out so I don't forget to bring it up at my appointment. I've been following your posts, Trasee, as well, particularly the back to work posts. I'm only 7 weeks and a few days post-op but was really shocked when I couldn't go back to work, even part-time, after 4 weeks. I knew the surgery was major but somehow didn't wrap my head around it until then. I'm of 2 thoughts on the work thing. I need to go back, at least part-time (which I worked anyway) for financial reasons (only planned on 8 weeks off) but am terrified of pushing myself to early and ending up hurt worse or not healing correctly.

    I'll be sure to update after I see my surgeon next Thursday and see what he and his PA say about the new, different pain I've been experiencing, as well as their thoughts on the return of my left leg nerve pain.
  • Thanks for the input everyone. To answer the big question of how much he aligned it, He moved L4 approximately 12-13mm. Doesn't sound like much be it is huge when you consider I was 17mm(x-ray) 13mm(MRI) slipped it was Grade3 on x-ray standing up and Grade2 on MRI laying down so it was very unstable.

    Gwennie I hadn't even thought of the adjustment my body was making to being near straight again. It took 10 years to get that far out of line and I'm asking it to be right in 6 months. Seems kind of silly when I look at it that way. If it took 10 years to get that bad it isn't going to get better overnight. I'm hoping it goes away on it's own. Like I said I was biting the bullet and trying to just deal with the new pain without painkillers and no Nsaids. I've recently tried biofreeze gel it doesn't really work for the pain but the burning helps distract from the pain for a little while, kind of along the lines of the tens unit but a lot more portable than the machine.

    I'm actually really pleased with my doctor. Saying I love him isn't really an overstatement. From the get go I told him I try too hard to avoid saying how much pain I'm truely in. It comes from the school of thought of the earlier I ask for help the earlier I will be disabled. My grandmother was alway stubborn and always said if you use a wheelchair for a few days you don't stop using a wheelchair. So I always try to remember that analagy. It's kind of like giving up, at least in my mind. Anyway if you need a good doctor in Southern Indiana PM me and I will give you his name and number.

    Thanks you all for your kind words and I'm going to check frequently for everyone's updates. Seems I read much more than I post.
  • Hi lilac,

    I just wanted to add that one thing you might try to get some pain relief is either dry needling or trigger point injections into some of the soft tissue around your hardware (as long as your surgeon approves, and of course no cortisone in the trigger point injections). I was having pain from the scar tissue that formed around the screws in my pelvis, and one round of dry needling really knocked my pain levels down. What my surgeon and PT told me was that a lot of times the scar tissue itself is the source of pain and not the hardware, so by breaking up the scar tissue you can sometimes get great pain relief and avoid hardware removal. It's a pretty easy, relatively non-invasive thing that you might consider giving a try.
  • Thanks for the suggestions Lala I will ask my doctor about trigger point injections.
  • I had my 8 week post-op appointment last Thursday and my PA just loved your orthodontist comparison!

    I was happy to hear all my hardware is in place and I am fusing beautifully, in fact, better then expected. Apparently they discovered during surgery my bones were alot softer then expected.

    Other then a sudden onset of both of my ankles swelling, which she wasn't too concerned about and said was normal, I feel like I have turned a corner in the past week, and am starting to feel a lot better. I'm still incredibly tired and my muscles are all sore by evening but I'm finding I don't really need the "as needed" valium and percocets except maybe around bedtime. I am still on 20 mg Oxycontin in the a.m. and was switched over to 20 mg of Oxycodone at bedtime in order to start tapering off of that.

    She delayed my return to work, just part-time, for one more week, this week, because of the ankle swelling and to make sure it gets better, not worse. They are both still swelling, but not as bad as last week. I was told to knock 5 minutes off of each of my three 25 minute walks per day.

    I'm relieved to hear good news after not hearing it at my first post-op. Will be glad to get back to work and stopped into my office after my appointment last week. I was getting worried they would think they didn't need me anymore but was glad to see my boss happy to have an exact return date for me and start giving me a list of things he's been waiting for me to return to get done. We'll see if I'm still happy to get back to work after a day or two. Luckily I worked part-time, with flexible hours, prior to my surgery and have a wonderful boss.

    Have a follow-up with my surgeon on the 30th of this month. If all is well at that time, will most likely be released until the six month mark, and without physical therapy.

    I know I'll have some rough days in there but feel like I can see the light at the end of the tunnel now and that surgery was worth it. Hopefully anyone who's having a rough day will read this and know that it does get better.

    And I wanted Gwennie to know just how much my PA loved her explanation. She said she may use it for future explanations.
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